Mucositis-associated bloodstream infections in adult haematology patients with fever during neutropenia: risk factors and the impact of mucositis severity.
Bacteremia
Candidemia
Chemotherapy
Fever
Mucositis
Neutropenia
Sepsis
Stem cell transplantation
Typhlitis
Journal
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
ISSN: 1433-7339
Titre abrégé: Support Care Cancer
Pays: Germany
ID NLM: 9302957
Informations de publication
Date de publication:
08 Aug 2024
08 Aug 2024
Historique:
received:
04
12
2023
accepted:
31
07
2024
medline:
8
8
2024
pubmed:
8
8
2024
entrez:
8
8
2024
Statut:
epublish
Résumé
Haematology patients with high-risk neutropenia are prone to mucosal-barrier injury-associated laboratory-confirmed bloodstream infections (MBI-LCBI). We assessed risk factors for MBI-LCBI including candidaemia in neutropenic haematology patients with fever. This prospective observational study was performed in six dedicated haematology units in the Netherlands. Eligible haematology patients had neutropenia < 500/mL for ≥ 7 days and had fever. MBI-LCBIs were classified according to Centers for Disease Control (CDC) definitions and were followed until the end of neutropenia > 500/mL or discharge. We included 416 patients from December 2014 until August 2019. We observed 63 MBI-LCBIs. Neither clinical mucositis scores nor the blood level of citrulline at fever onset was associated with MBI-LCBI. In the multivariable analysis, MASCC-score (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05 to 1.29 per point decrease), intensive chemotherapy (OR 3·81, 95% CI 2.10 to 6.90) and Pichia kudriavzevii (formerly Candida krusei) colonisation (OR 5.40, 95% CI 1.75 to 16.7) were retained as risk factors for MBI-LCBI, while quinolone use seemed protective (OR 0.42, 95% CI 0.20 to 0.92). Citrulline level (OR 1.57, 95% CI 1.07 to 2.31 per µmol/L decrease), active chronic obstructive pulmonary disease (OR 15.4, 95% CI 1.61 to 14.7) and colonisation with fluconazole-resistant Candida (OR 8.54, 95% CI 1.51 to 48.4) were associated with candidaemia. In haematology patients with fever during neutropenia, hypocitrullinaemia at fever onset was associated with candidaemia, but not with bacterial MBI-LCBI. Patients with intensive chemotherapy with a low MASCC-score and colonisation with Pichia kudriavzevii had the highest risk of MBI-LCBI. ClinicalTrials.gov (NCT02149329) at 19-NOV-2014.
Identifiants
pubmed: 39115709
doi: 10.1007/s00520-024-08776-w
pii: 10.1007/s00520-024-08776-w
doi:
Banques de données
ClinicalTrials.gov
['NCT02149329']
Types de publication
Journal Article
Observational Study
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
579Subventions
Organisme : ZonMw
ID : 836011030
Pays : Netherlands
Organisme : ZonMw
ID : 836011030
Pays : Netherlands
Organisme : Fonds NutsOhra
ID : 1302-002
Organisme : Fonds NutsOhra
ID : 1302-002
Informations de copyright
© 2024. The Author(s).
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